Laparoscopic Duodenojejunostomy for Superior Mesenteric Artery Syndrome

Laparoscopy has become an invaluable part of the surgeon’s armamentarium. It has proven diagnostic and therapeutic benefits for a wide spectrum of disease. This video illustrates the role of laparoscopy for Superior Mesenteric Artery Syndrome.

The aim of this video is to demonstrate key concepts associated with laparoscopic duodenojejunostomy. Management algorithms are discussed and laparoscopic techniques are demonstrated. Preoperative imaging includes CT angiograms with reconstructed views. An intraoperative video highlights important anatomical landmarks as well as key techniques associated with a laparoscopic duodenojejunostomy.

This is a case report of a 20 year old male with a history of hemochromatosis whose presenting complaint was chronic but significant weight loss. Attempts at medical management and aggressive enteral nutrition were unsuccessful. While recieving total parenteral nutrition there was an acute rise of liver function tests, which was worrisome because of his history of hemochromatosis. He was subsequently referred to Gastrointestinal Surgery for surgical consideration. Exhaustive preoperative workup identified the source to be duodenal obstruction secondary to external compression of the third portion of the duodenum by the superior mesenteric artery, hence superior mesenteric artery syndrome. Laparoscopic duodenojejunostomy was performed, highlighting various anatomic landmarks and technical concepts. Postoperative imaging demonstrated relief of the obstruction, and the patients longterm outcome was successful.

Laparoscopy is a safe, effective, and readily available alternative for patients with Superior Mesenteric Artery Syndrome, that fails to resolve with alternative approaches. Reflecting improved patient outcomes, the indications for laparoscopy continue to expand. Thus, making advanced laparoscopy a highly valuable adjunct to surgical practice.

Session: Podium Presentation

Program Number: V018

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